| BackgroundCongenital Radioulnar Synostosis is a kind of congenital developmental malformation with bone or cartilage junction at the proximal end of ulna and radius,which is shown as pronation deformity of forearm fixed at a certain angle.The development of the upper limb begins about 26 days after the embryo,and the separation of the ulna and the radius begins at the distal end,during which the ulna and the proximal end of the radius are joined together by a chondroid membrane.Genetic or other teratogenic factors may affect the further separation and differentiation of ulna and radius resulting in the failure of ulna and radius separation resulting in Congenital Radioulnar Synostosis.The lesion can be involved in one or two sides.About 60% ~80% of the disease is bilateral involvement,male is more common than female,the ratio of male to female is about 3: 2,the incidence is about 0.2 ‰.It is reported that 25% of the cases have familial heredity,most of them are paternal.Most scholars believe that the disease is related to heredity and gene mutation.The main clinical manifestation of the disease is that there is no movement between the ulna and radius,the forearm is fixed at a certain angle of pronation,and there is no supination function.In some patients,elbow extension was limited and wrist flexion and extension were not restricted.The degree of limitation of forearm function is determined by the severity of deformity and bilateral involvement.At present,the treatment of the disease is difficult.The mild deformity can be compensated by shoulder and wrist joint activities,which has little effect on normal life and work,and generally does not require surgical treatment.Severe deformities tend to fix the forearm in the extreme pronation position,resulting in various functional disorders of the forearm,which are difficult to compensate through shoulder and wrist movement,seriously affecting normal life and work.It is generally necessary to restore part of the forearm function through surgical treatment to meet the basic daily needs.At present,there is a great controversy about the surgical treatment of the disease.According to the domestic and foreign literature,the surgical methods can be divided into two categories: one is to reconstruct the proximal ulnar joint by separating the fusion site of ulnar and radius,and to restore the function of rotation of forearm.The other is rotary osteotomy of the ulna and radius,through the osteotomy of the ulna and radius,the forearm is fixed in an appropriate functional position.The forearm pronation deformity is corrected,and the forearm motion is satisfied with the basic daily life through the functional compensation of the wrist joint and the shoulder joint.But the forearm is still fixed in a certain position,and the forearm rotation function has not been restored.This article mainly uses the local subcutaneous pedicle fat flap to fill the separation fusion area and the radius short reduction osteotomy plate internal fixation to treat Congenital Radioulnar Synostosis,and analyzes its curative effect,provides the objective basis for Congenital Radioulnar Synostosis surgery treatment.ObjectiveTo investigate the effect of local subcutaneous pedicle fat flap filling and separating fusion area and short radius osteotomy plate internal fixation for Congenital Radioulnar Synostosis.MethodFrom February 2014 to April 2017,36 children(21 males and 15 females)with Congenital Radioulnar Synostosis were retrospectively analyzed.The age of 2.5 to 4.5 years old,the average age of 3.1 years.There were 5 children with bilateral limbs,31 patients with unilateral limbs(14 patients with left limbs and 17 patients with right limbs).The forearm fixed pronation deformity was 30 ° to 90 °,with an average of 71.6 °.According to Cleary-Omer classification,there were 8 cases of type ?,17 sides of type ? and 16 sides of type ?,all of them were treated by local subcutaneous pedicle fat flap filling and fusion area short radius osteotomy plate internal fixation to restore forearm rotation function.The range of elbow motion,muscle strength and pain were evaluated by Broberg and Morrey's elbow scoring standard before and after operation,and the ability of daily life of affected limbs before and after operation were evaluated by Failla grading.ResultsA total of 36 children(41 affected limbs)were followed up for 11 to 38 months(mean 30 months).Through the imaging examination and physical examination of the affected limbs,all the osteotomy sites healed at the first stage without infection,malunion and delayed healing,nonunion,nerve injury and other complications,according to the evaluation criteria of osteotomy healing,all cases were evaluated as cured.At the last follow-up,the flexion motion of the elbow joint of the affected limb was not decreased,the forearm pronation motion was 15 ° to 45 °(mean 30.1 °)and the forearm supination motion was 10 °~40 °(mean 22.6 °).At the last follow-up,the scores of Broberg and Morrey increased from(85.63 ±1.02)to(91.76 ±1.79)(P < 0.05).According to the Failla grading criteria,the excellent sides were 0,good 3,fair 9,poor 29,excellent and good rate were 7.3% preoperative.At the last follow-up,excellent 6,good 28,fair 7,poor 0,excellent and good rate were 82.9%.Before and after operation,the excellent good number and the fair poor difference were matched with chi-square test.The difference was statistically significant(P < 0.05).The rotatory function of the affected limb was restored in this group.Basically can meet the needs of daily life.The families of the children were quite satisfied with the effect of operation.ConclusionThe treatment of Congenital Radioulnar Synostosis with local subcutaneous pedicled fat flap filling and fusion region with short radius osteotomy and internal fixation can correct forearm malformation.It can restore the function of forearm rotation and improve the quality of life of children.It is a simple and effective method to treat Congenital Radioulnar Synostosis. |
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